Okaloosa EMS Customer Satisfaction Survey

Please provide some information regarding when Okaloosa County EMS services were used.

Date / Time

Date

Under 18

18 - 30

31 - 44

45 - 54

55 - 64

65 or older

Female

Male

Prefer not to disclose

Prefer to self describe:

Patient

Parent/Guardian

Spouse

Other Family

Other Caregiver

Illness or injury requiring a 911 call

Transfer from one hospital to another hospital

Transport from the hospital to a nursing home, assisted living facility, or residence

Transport from and/or to a doctor's or dialysis appointment

Other (please specify)